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Depression and Engagement in Care Among Newly Diagnosed HIV-Infected Adults in Johannesburg, South Africa

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Abstract

Delayed engagement in HIV care threatens the success of HIV treatment programs in sub-Saharan Africa and may be influenced by depression. We examined the relationship between depression prior to HIV diagnosis and engagement in HIV care at a primary care clinic in Johannesburg, South Africa. We screened 1683 patients for depression prior to HIV testing using the Patient Health Questionnaire-9. Among patients who tested positive for HIV we assessed linkage to HIV care, defined as obtaining a CD4 count within 3 months. Among those who linked to care and were eligible for ART, we assessed ART initiation within 3 months. Multivariable Poisson regression with a robust variance estimator was used to assess the association between depression and linkage to care or ART initiation. The prevalence of HIV was 26 % (n = 340). Among HIV-infected participants, the prevalence of depression was 30 %. The proportion of linkage to care was 80 % among depressed patients and 73 % among patients who were not depressed (risk ratio 1.08; 95 % confidence interval 0.96, 1.23). Of the participants who linked to care, 81 % initiated ART within 3 months in both depressed and not depressed groups (risk ratio 0.99; 95 % confidence interval 0.86, 1.15). Depression was not associated with engagement in HIV care in this South African primary care setting. Our unexpected findings suggest that some depressed HIV-infected patients might be more likely to engage in care than their counterparts without depression, and highlight the complex relationship between depression and HIV infection. These findings have led us to propose a new framework relating HIV infection, depression, and the population under study.

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References

  1. Hughes J, Jelsma J, Maclean E, Darder M, Tinise X. The health-related quality of life of people living with HIV/AIDS. Disabil Rehabil. 2004;26(6):371–6.

    Article  PubMed  Google Scholar 

  2. Kagee A, Martin L. Symptoms of depression and anxiety among a sample of South African patients living with HIV. AIDS Care. 2010;22(2):159–65.

    Article  PubMed  Google Scholar 

  3. Myer L, Smit J, Roux LL, Parker S, Stein DJ, Seedat S. Common mental disorders among HIV-infected individuals in South Africa: prevalence, predictors, and validation of brief psychiatric rating scales. AIDS Patient Care STDS. 2008;22(2):147–58.

    Article  PubMed  Google Scholar 

  4. Olley BO, Seedat S, Nei DG, Stein DJ. Predictors of major depression in recently diagnosed patients with HIV/AIDS in South Africa. AIDS Patient Care STDS. 2004;18(8):481–7.

    Article  CAS  PubMed  Google Scholar 

  5. Lawler K, Mosepele M, Seloilwe E, Ratcliffe S, Steele K, Nthobatsang R, et al. Depression among HIV-positive individuals in Botswana: a behavioral surveillance. AIDS Behav. 2011;15(1):204–8.

    Article  PubMed  Google Scholar 

  6. Kinyanda E, Hoskins S, Nakku J, Nawaz S, Patel V. Prevalence and risk factors of major depressive disorder in HIV/AIDS as seen in semi-urban Entebbe district, Uganda. BMC Psychiatry. 2011;11:205.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Nakimuli-Mpungu E, Musisi S, Katabira E, Nachega J, Bass J. Prevalence and factors associated with depressive disorders in an HIV + rural patient population in southern Uganda. J Affect Disord. 2011;135(1–3):160–7.

    Article  CAS  PubMed  Google Scholar 

  8. Nakimuli-Mpungu E, Bass JK, Alexandre P, Mills EJ, Musisi S, Ram M, et al. Depression, alcohol use and adherence to antiretroviral therapy in sub-Saharan Africa: a systematic review. AIDS Behav. 2012;16(8):2101–18.

    Article  PubMed  Google Scholar 

  9. Tomlinson M, Grimsrud AT, Stein DJ, Williams DR, Myer L. The epidemiology of major depression in South Africa: results from the South African stress and health study. S Afr Med J. 2009;99(5 Pt 2):367–73.

    PubMed  PubMed Central  Google Scholar 

  10. Smit J, Myer L, Middelkoop K, Seedat S, Wood R, Bekker LG, et al. Mental health and sexual risk behaviours in a South African township: a community-based cross-sectional study. Public Health. 2006;120(6):534–42.

    Article  CAS  PubMed  Google Scholar 

  11. Simoni JM, Safren SA, Manhart LE, Lyda K, Grossman CI, Rao D, et al. Challenges in addressing depression in HIV research: assessment, cultural context, and methods. AIDS Behav. 2011;15(2):376–88.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Leserman J. Role of depression, stress, and trauma in HIV disease progression. Psychosom Med. 2008;70(5):539–45.

    Article  PubMed  Google Scholar 

  13. Carrico AW, Riley ED, Johnson MO, Charlebois ED, Neilands TB, Remien RH, et al. Psychiatric risk factors for HIV disease progression: the role of inconsistent patterns of antiretroviral therapy utilization. J Acquir Immune Defic Syndr. 2011;56(2):146–50.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Cook JA, Grey D, Burke J, Cohen MH, Gurtman AC, Richardson JL, et al. Depressive symptoms and AIDS-related mortality among a multisite cohort of HIV-positive women. Am J Public Health. 2004;94(7):1133–40.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Ulett KB, Willig JH, Lin HY, Routman JS, Abroms S, Allison J, et al. The therapeutic implications of timely linkage and early retention in HIV care. AIDS Patient Care STDS. 2009;23(1):41–9.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Giordano TP, Gifford AL, White AC Jr, Suarez-Almazor ME, Rabeneck L, Hartman C, et al. Retention in care: a challenge to survival with HIV infection. Clin Infect Dis. 2007;44(11):1493–9.

    Article  PubMed  Google Scholar 

  17. Park WB, Choe PG, Kim SH, Jo JH, Bang JH, Kim HB, et al. One-year adherence to clinic visits after highly active antiretroviral therapy: a predictor of clinical progress in HIV patients. J Intern Med. 2007;261(3):268–75.

    Article  CAS  PubMed  Google Scholar 

  18. Feldacker C, Johnson D, Hosseinipour M, Phiri S, Tweya H. Who starts? Factors associated with starting antiretroviral therapy among eligible patients in two, public hiv clinics in Lilongwe, Malawi. PLoS One. 2012;7(11):e50871.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Clouse K, Pettifor AE, Maskew M, Bassett J, Van Rie A, Behets F, et al. Patient retention from HIV diagnosis through one year on antiretroviral therapy at a primary healthcare clinic in Johannesburg, South Africa. J Acquir Immune Defic Syndr. 2013;62:e39.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Tegger MK, Crane HM, Tapia KA, Uldall KK, Holte SE, Kitahata MM. The effect of mental illness, substance use, and treatment for depression on the initiation of highly active antiretroviral therapy among HIV-infected individuals. AIDS Patient Care STDS. 2008;22(3):233–43.

    Article  PubMed  Google Scholar 

  21. Wagner GJ, Goggin K, Remien RH, Rosen MI, Simoni J, Bangsberg DR, et al. A closer look at depression and its relationship to HIV antiretroviral adherence. Ann Behav Med. 2011;42(3):352–60.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Gonzalez JS, Batchelder AW, Psaros C, Safren SA. Depression and HIV/AIDS treatment nonadherence: a review and meta-analysis. J Acquir Immune Defic Syndr. 2011;58(2):181–7.

    Article  PubMed  Google Scholar 

  23. Springer SA, Dushaj A, Azar MM. The impact of DSM-IV mental disorders on adherence to combination antiretroviral therapy among adult persons living with HIV/AIDS: a systematic review. AIDS Behav. 2012;16(8):2119–43.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Berg MB, Safren SA, Mimiaga MJ, Grasso C, Boswell S, Mayer KH. Nonadherence to medical appointments is associated with increased plasma HIV RNA and decreased CD4 cell counts in a community-based HIV primary care clinic. AIDS Care. 2005;17(7):902–7.

    Article  CAS  PubMed  Google Scholar 

  25. Bhatia R, Hartman C, Kallen MA, Graham J, Giordano TP. Persons newly diagnosed with HIV infection are at high risk for depression and poor linkage to care: results from the Steps Study. AIDS Behav. 2011;15(6):1161–70.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Nachega JB, Mutamba B, Basangwa D, Nguyen H, Dowdy DW, Mills EJ, et al. Severe mental illness at ART initiation is associated with worse retention in care among HIV-infected Ugandan adults. Trop Med Int Health. 2013;18(1):53–7.

    Article  CAS  PubMed  Google Scholar 

  27. Ramirez-Avila L, Regan S, Giddy J, Chetty S, Ross D, Katz JN, et al. Depressive symptoms and their impact on health-seeking behaviors in newly-diagnosed HIV-infected patients in Durban, South Africa. AIDS Behav. 2012;16:2226–35.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606–13.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Pence BW, Gaynes BN, Atashili J, O’Donnell JK, Tayong G, Kats D, et al. Validity of an interviewer-administered patient health questionnaire-9 to screen for depression in HIV-infected patients in Cameroon. J Affect Disord. 2012;143:208–13.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Monahan PO, Shacham E, Reece M, Kroenke K, Ong’or WO, Omollo O, et al. Validity/reliability of PHQ-9 and PHQ-2 depression scales among adults living with HIV/AIDS in western Kenya. J Gen Intern Med. 2009;24(2):189–97.

    Article  PubMed  Google Scholar 

  31. Adewuya AO, Ola BA, Afolabi OO. Validity of the patient health questionnaire (PHQ-9) as a screening tool for depression amongst Nigerian university students. J Affect Disord. 2006;96(1–2):89–93.

    Article  PubMed  Google Scholar 

  32. Akena D, Joska J, Obuku EA, Stein DJ. Sensitivity and specificity of clinician administered screening instruments in detecting depression among HIV-positive individuals in Uganda. AIDS Care. 2013;25:1245–52.

    Article  PubMed  Google Scholar 

  33. Tsai AC. Reliability and validity of depression assessment among persons with HIV in sub-Saharan Africa: systematic review and meta-analysis. J Acquir Immune Defic Syndr. 2014;66(5):503–11.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Cholera R, Gaynes BN, Pence BW, Bassett J, Qangule N, Macphail C, et al. Validity of the Patient Health Questionnaire-9 to screen for depression in a high-HIV burden primary healthcare clinic in Johannesburg, South Africa. J Affect Disord. 2014;167:160–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42(2):377–81.

    Article  PubMed  Google Scholar 

  36. Olde Hartman T, van Rijswijk E, van Ravesteijn H, Hassink-Franke L, Bor H, van Weel-Baumgarten E, et al. Mental health problems and the presentation of minor illnesses: data from a 30-year follow-up in general practice. Eur J Gen Pract. 2008;14(Suppl 1):38–43.

    Article  PubMed  Google Scholar 

  37. Berghofer A, Roll S, Bauer M, Willich SN, Pfennig A. Screening for depression and high utilization of health care resources among patients in primary care. Community Ment Health J. 2014;50:753–8.

    Article  PubMed  Google Scholar 

  38. Rosen S, Fox MP. Retention in HIV care between testing and treatment in sub-Saharan Africa: a systematic review. PLoS Med. 2011;8(7):e1001056.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Pence BW, O’Donnell JK, Gaynes BN. Falling through the cracks: the gaps between depression prevalence, diagnosis, treatment, and response in HIV care. AIDS. 2012;26(5):656–8.

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgments

The authors wish to thank the data collection team- Happiness Ndobe, Mpho Mbulaheni, Nonhlanhla Msimango, and Victor Lerato. We thank Dr. Annelies Van Rie for her guidance and support in implementing the study. We are also deeply grateful to the patients and staff at Witkoppen Health and Welfare Center.

Funding

This work was supported by the National Institute of Mental Health grant 5F30MH096664, and National Institutes of Health Office of the Director, Fogarty International Center, Office of AIDS Research, National Cancer Center, National Heart, Blood, and Lung Institute, and the NIH Office of Research for Women’s Health through the Fogarty Global Health Fellows Program Consortium comprised of the University of North Carolina, John Hopkins, Morehouse and Tulane (1R25TW009340-01) and the American Recovery and Reinvestment Act. Financial support for REDCAP was provided by Grant UL1RR025747 from the Clinical and Translational Science Award program of the Division of Research Resources, National Institutes of Health.

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Authors and Affiliations

  1. UNC School of Medicine, Pediatric Education Office, 230 MacNider Hall, Campus Box 7593, Chapel Hill, NC, 27599, USA

    R. Cholera

  2. Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA

    B. W. Pence, A. Pettifor & W. C. Miller

  3. Department of Psychiatry, UNC School of Medicine, Chapel Hill, NC, USA

    B. N. Gaynes

  4. Witkoppen Health and Welfare Center, Johannesburg, South Africa

    J. Bassett & N. Qangule

  5. Collaborative Research Network for Mental Health and Well-being in Rural Communities, University of New England, Armidale, Australia

    C. Macphail

  6. Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa

    C. Macphail

  7. Department of Medicine, UNC School of Medicine, Chapel Hill, NC, USA

    W. C. Miller

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  1. R. Cholera
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Corresponding author

Correspondence to R. Cholera.

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The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the Institutional Review Board at the University of North Carolina and the Human Research Ethics Committee at the University of Witwatersrand and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

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Cholera, R., Pence, B.W., Gaynes, B.N. et al. Depression and Engagement in Care Among Newly Diagnosed HIV-Infected Adults in Johannesburg, South Africa. AIDS Behav 21, 1632–1640 (2017). https://doi.org/10.1007/s10461-016-1442-6

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